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NPI Code Detail

MEDICARE: PETER JOSEPH SHAW MD

MEDICARE: PETER JOSEPH SHAW MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician01087769AIN
2207P00000XEmergency Medicine Physician4351044601MI
3390200000XStudent in an Organized Health Care Education/Training ProgramMI

General Provider Information

NPI Number : 1568924454
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER JOSEPH SHAW MD
Provider Business Mailing Address
First Line : 7950 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4160
Country : US
Telephone Number : 260-435-7001
Fax Number :
Provider Business Practice Location Address
First Line : 7950 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4160
Country : US
Telephone Number : 260-435-7001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2019
Last Update Date : 01/08/2024

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